How Much Is Health Insurance in Tennessee?

Health insurance costs in Tennessee vary significantly based on personal and plan-related factors. Understanding these elements helps residents manage healthcare expenses and access medical services.

Factors Influencing Health Insurance Costs in Tennessee

Monthly premiums and out-of-pocket costs for health insurance in Tennessee are influenced by several factors. Age is a determinant, with premiums increasing as people get older due to higher anticipated healthcare needs. Location within Tennessee also affects costs, as market dynamics and provider networks vary by region.

Tobacco use impacts premiums; insurers can add a surcharge of up to 50%. This surcharge is not covered by federal financial assistance. Family size also plays a role, as adding dependents increases the total premium.

The type of health plan influences premiums and network flexibility. Common plan types include:
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Exclusive Provider Organizations (EPOs)
Point of Service (POS) plans

HMOs and EPOs often have restricted networks and require specialist referrals, leading to lower premiums. PPOs offer greater flexibility, including out-of-network options, often resulting in higher premiums.

Health insurance plans are categorized into “metal tiers”: Bronze, Silver, Gold, and Platinum. Each tier balances monthly premiums with out-of-pocket costs. Bronze plans have the lowest premiums but highest deductibles and cost-sharing. Silver plans offer moderate premiums and cost-sharing. Gold and Platinum plans have higher premiums but lower deductibles, copayments, and coinsurance, providing more comprehensive coverage.

Cost-sharing elements include:
A deductible: The amount paid for covered services before insurance begins to pay.
Copayments: Fixed fees for specific services, like doctor visits or prescription drugs.
Coinsurance: A percentage of the service cost paid after the deductible is met.
Out-of-pocket maximum: A cap on the total amount an individual pays for covered medical expenses in a year.

Average Health Insurance Premiums in Tennessee

The average cost of health insurance in Tennessee varies. In 2024, the average monthly premium for a benchmark plan purchased through the Marketplace was about $501. This is before financial assistance or subsidies, which can significantly reduce the amount paid.

For individual coverage, average monthly premiums by metal tier are: Bronze plans range from $378 to $537. Silver plans, balancing premiums with cost-sharing, are typically $490 to $648 per month. Gold plans, with lower out-of-pocket costs but higher premiums, can average $504 to over $800.

Family coverage premiums are higher due to more individuals covered. A family of four in Tennessee might pay around $1,785 per month. For a couple, the average monthly premium could be about $1,116. Family size directly correlates with the total premium.

Age significantly impacts individual premium costs, with younger individuals typically paying less. For example, a 21-year-old might find a Bronze plan for about $351 per month. A 60-year-old could face premiums over $950 for a Bronze plan or $1,485 for a Gold plan. These figures are unsubsidized; actual payments can be lower with financial assistance.

Reducing Your Health Insurance Costs in Tennessee

Programs and options help manage health insurance expenses in Tennessee. Premium tax credits, or subsidies, are federal funds that lower monthly premiums. Eligibility is based on household income relative to the Federal Poverty Level (FPL), with those at or above 100% FPL potentially qualifying.

Through 2025, there is no upper income limit if a benchmark plan costs over 8.5% of household income. Credits can be applied directly to monthly premiums or claimed as a refundable tax credit. In 2024, the average premium tax credit for Tennesseans was $581 per month, reducing the average enrollee’s premium to about $66 per month.

Cost-Sharing Reductions (CSRs) are additional subsidies that lower out-of-pocket expenses like deductibles, copayments, and coinsurance. CSRs are exclusively available for Silver plans purchased through the Health Insurance Marketplace. To qualify, individuals must be eligible for premium tax credits and have household incomes between 100% and 250% of the FPL.

TennCare is Tennessee’s Medicaid program, providing comprehensive health coverage at little to no cost for low-income residents. Eligibility is based on income and resource limits, varying by household composition. Categories include low-income individuals and families, pregnant women (up to 200% FPL), and children (up to 255% FPL for CoverKids). Tennessee has not expanded its Medicaid program to cover all adults solely based on income under the Affordable Care Act.

Many individuals get health insurance through employer-sponsored plans, which can reduce costs. Employers often contribute a portion of the premium, lowering the employee’s share. These plans offer various coverage levels and network options, providing another avenue for affordable health coverage.